Service delivery and quality of care for individuals with mental illness

[摘要] Mental illness and substance use illnesses are the most common cause of disease burden in the United States. Over half of individuals with mental illness do not receive appropriate care for their illnesses. This often results in poor outcomes like early mortality, more hospitalizations and increased use of emergency departments (EDs). Provider and payor systems have embarked on delivery system reforms that aim to improve quality of care and reduce health disparities for these individuals. In this dissertation we examine three aspects of health care quality – readmission, ED use and continuity of care – to explore their impact for individuals with mental illness. We show that individuals with mental illness have greater odds of thirty day readmission after acute hospitalization and this odds is increased if medications are dropped after discharge. We categorize individuals with mental illness who frequent the ED and show that high utilizers have a significantly greater rate of substance use comorbidities than occasional utilizers. We also show that high utilizers do not use outpatient services concomitant with their ED use.Finally, we examine the care coordination in physical and behavioral health specialties for seriously mentally ill individuals who have type II diabetes and its association with ED use. We show that increased care coordination in physical health settings is associated with a lower rate of ED visits. Public Health SignificanceWe expect our study to inform health care facilities and policy makers in developing health care delivery systems and improve quality of care for individuals with mental illness.

[发布机构] the University of Pittsburgh